Research Reports - Telephone and in-person cognitive behavioral therapy for major depression after traumatic brain injury

Major depressive disorder (MDD) is prevalent after TBI, yet there is a lack of
evidence regarding effective treatment approaches. We conducted a
choice-stratified randomized controlled trial in 100 adults with MDD within 10
years of complicated mild to severe TBI to test the effectiveness of brief
cognitive behavioral therapy administered over the telephone (CBT-T, n=40) or
in-person (CBT-IP, n=18), compared to usual care (UC, n=42). Participants were
recruited from clinical and community settings throughout the United States. The
main outcomes were change in depression severity on the clinician-rated 17-item
Hamilton Depression Rating Scale (HAMD-17) and the patient-reported Symptom
Checklist-20 (SCL-20) over 16 weeks. There was no significant difference between
the combined CBT and UC groups over 16 weeks on the HAMD-17 (Treatment
effect=1.2, 95% CI: -1.5 to 4.0; P=0.37) and a non-significant trend favoring CBT
on the SCL-20 (Treatment effect= 0.28, 95% CI: -0.03 to 0.59; P=0.074). In
follow-up comparisons, the CBT-T group had significantly greater improvement on
the SCL-20 compared to the UC group (Treatment effect= 0.36, 95% CI: 0.01 to
0.70; P=0.043) and completers of >8 CBT sessions had significantly improved
SCL-20 scores compared to the UC group (Treatment effect = 0.43, 95% CI: 0.10 to
0.76; P=0.011). CBT participants reported significantly greater symptom
improvement (P=0.010) and greater satisfaction with depression care (P<0.001),
compared to UC. In-person and telephone administered CBT are acceptable and
feasible in persons with TBI. Although further research is warranted, telephone
CBT holds particular promise for enhancing access and adherence to effective
depression treatment.